The Fix has a provocative article on the growing use of buprenorphine maintenance. Over the last several years we’ve watched long-term maintenance become the norm and it has been a growing concern at Dawn Farm, particularly as we’ve had growing numbers of people misusing the drug and others seeking help getting detoxed from buprenorphine.

She presents the dilemma for addicts this way:

Should they take buprenorphine, or “bupe,” long term mainly to avoid cravings—and the junkie lifestyle—or heal their bodies by detoxing and staying clean, which is harder and, in certain ways, riskier? Weighing the costs and benefits of each approach is a very personal, even existential, matter, and science can offer only limited advice, since there are no studies of long-term use of buprenorphine in former opiate addicts. We’re pretty much on our own.

Addicts are not alone in wrestling this this dilemma. It has also been a difficult subject within our own community of professional helpers and it’s not going away. While this has been on the minds of many practitioners and addicts, I’ve never seen an article question buprenorphine maintenance.

I have a strong point of view on the subject and believe that the following principles should inform any services for addicts: that drug-free recovery is possible for most opiate addicts and; that drug free treatment of the appropriate duration and intensity should be made available to every every opiate addict.

Also, more than ever, I’m very comfortable with addicts being given their choice of treatment options. I’m convinced most will migrate toward full, drug-free recovery. Addicts hate their addiction and want to be free of it.

So, with my bias made plain, a few important questions leap out to me:

Is is necessary?

Is it helpful?

Is it harmful?

Is it compatible with other treatments and paths to recovery?

Let’s take these one at a time. Please, keep in mind that, while I have an opinion on the subject, I’m trying to unpack all of this and muddle through it.

Is it necessary?

One group of people is consistently offered care of appropriate intensity and duration with the expectation that they can achieve full recovery—their outcomes are consistently stellar. That group is health professionals. This tells me, that in a broad sense, it’s not necessary.

One of the arguments is that addicts don’t want drug-free recovery:

“The people who try abstinence, they’re like the starfish on the beach. There aren’t many of them.”

As I said before, I think most will migrate toward drug-free recovery. There are two big conditions on this belief. First, that addicts are offered access to quality recovery support and treatment services of adequate intensity and duration. The second is that the helpers they encounter must consistently communicate hope for full recovery.

Overdose prevention also falls into this category:

In France, where the drug was in use for a decade prior to FDA approval, fatal overdoses of heroin and other opiates fell by 80%.

This is a frequently cited argument for buprenorphine maintenance. It’s compelling if you believe that stable recovery is unlikely—we don’t based treatment decisions for health professionals on an expectation of relapse and overdose.

Is it helpful?

I’ll let one of the advocates in the article make this case:

[Junig’s] advocacy of bupe maintenance is based on “the least worst” logic. Most of his patients who have tried to detox off, he says, return to legal or illegal drug use. Worst of all, some OD. “I want addiction to be treated like every other chronic fatal illness,” he says. “We put people through treatment, they clean up, they come out looking good, we all congratulate ourselves—and then six months later, the patient dies,” he says. “And no one cares about this. There’s no review of what we might have done better, the way there would be if the patient died of a heart attack, for example.”

When patients take buprenorphine, he says, they quit stealing and lying, they become employable. “Especially if they’re over 40, they do well,” he says. “It’s like they’re taking their blood-pressure pill.”

We’re not seeing suboxone maintenance patients achieving stable recovery. It’s easy to counter that there’s a selection bias in our experience and I’m sure there’s a lot of truth to that, though our outpatient program typically has clients on suboxone maintenance.

Is it harmful?

One critic on the neurobiology of buprenorphine:

Switching from one opiate (heroin, methadone) to another (bupe) does not “heal” the neurological aspect of addiction, which is characterized in part by the phenomenon of tolerance: as long as exogenous opiods are taken, the body decreases its production of endorphins and increases the number of receptors.

…But Scanlan is a fierce opponent of such long-term bupe use. “There’s no way your brain chemistry can heal while on buprenorphine,” he says. “You’re continuing to give someone a narcotic.”

…He has noticed that at long-term doses of even 2 mg, bupe can block almost all of a person’s emotions. “They say to me after they’re off for a while, ‘Wow, I’m really having a full range of feelings,’” he says.

I share this concern and find it very credible, though I just don’t believe we know enough yet about the neurobiology of recovery to speak definitively on the matter.

And, while advocates argue that the drug offers freedom, the author offers her experience of it as diminishing but extending her bondage:

…of course I asked my doctor if I could stay on Suboxone forever. He had no more maintenance slots left. And then, two or three weeks in, still at 6 mg—I was dragging the taper out as long as I could, because I Felt So Well—the affair went sour. My appetites gradually diminished. My voice clogged up again. My attention was constantly dragged back to how I was feeling—and whether it was time for my next dose.

It took me six more weeks to get off Suboxone, and it was during that time I started going to meetings. I probably could have tapered more quickly, but what slowed my descent onto the tarmac was simple: I was afraid of having nothing left to take. I had taken painkillers every morning, to cope, for so many years. Now, fortunately, I don’t have to.

Note that she didn’t start going to meetings until she was close to discontinuing the medication. Is this a good argument against the use of a drug to manage a chronic illness? I don’t know. Large numbers of people on statins or blood pressure medications could control their symptoms with diet and exercise and improve the quality of their lives and global health. Are they less likely to make changes in diet and exercise because their can control some symptoms and reduce risks with a pill? Probably. Should doctors restrict access to these drugs because of this? Probably not. Should doctors settle for for this? I think not.

Is it compatible with other treatments and paths to recovery?

An obvious question is, “Why not bupe AND tradition treatment and recovery support?” I’ve already touched on this and I’m going to take the long way back around.

I’m convinced that the driving force behind much of this is not a conviction that buprenorphine maintenance is the ideal approach. Rather, it’s driven by a resignation to it being the best many practitioners can do—we can’t offer enough monitoring, we can’t offer more than short-term residential or inpatient, we can’t offer community based recovery support services, we can’t offer outpatient treatment of sufficient duration and intensity, we can’t address all of the client’s other problems that will interfere with recovery, etc.

I have two reactions to this. First, I understand the real world constraints most practitioners function within. I can respect choosing a second best option when the best is not available. However, I expect informed consent (If you were a doctor we’d send you to residential treatment and provide and advocacy for access to the best option. I don’t see this happening.

Second, when one thinks about addiction as a chronic illness, we have historically failed on one front and succeeded on another. We failed to conceptualize addiction as a chronic illness and sold treatment in an acute care model with time-limited doses of treatment provided with the expectation of permanent full recovery. We (Actually, mutual aid groups, rather than treatment, deserve the credit for this.) succeeded in creating long-term disease management support for the behavior and lifestyle changes needed to maintain recovery. What practitioner working with cardiac, obesity or type II diabetes patients wouldn’t envy our free, vibrant communities of support that help initiate and maintain these behavior and lifestyle changes over decades? They’d be crazy not to envy this. We’re not starting in the same place as practitioners trying to encourage diet and exercise. We’ve enjoyed considerable success for decades.

This migration to buprenorphine maintenance has not been one of adding a pharmacological tool to this historical strength. Rather it’s been a migration away from this strength. (Read the comments on the article and it becomes clear that neglect of these patients needs and preferences is not a rare experience.)

Clearly, this doesn’t have to be an either/or decision, but practitioners are telling us that buprenorphine clients don’t want the rest of the “recovery lifestyle”. Why is that? Is there something about the drug that reduces motivation to do so? Does it interfere with the experience of the benefits of the lifestyle?

22 responses to “The Suboxone “Solution””

I read this piece on the author’s blog “guineveregetssober.com” (an excellent blog). Her article and your thoughts on it are educational and interesting to me, as my son has been on bupe maintenance for over a year. When you see someone go from “junky” to college student, it’s easy to hail suboxone as a wonder drug. In my son’s case, I notice there is increasingly less talk of getting off, and more talk about how “it’s working for me.”

I’m torn about long term use. After witnessing the depravity of heroin addiction, I’m gun shy about advocating stopping the meds. It is, after all, not my recovery. I do know in my gut he is “scared” of changing anything for fear of relapse. He even has sleeping and exercise rituals that he follows rigidly. I think most addicts have compulsive personalities, and now he is compulsive about all he believes keeps him sober. He does go to NA, but does not feel safe admitting the bupe.

A lot of issues at play with medication assistance. Always helpful to read your thoughts.

As a recovering addict myself (heroin) was my drug of choice and as an active member in a 12 step fellowship my opinion is that treating drug addiction with another drug is just preventing an individual from the experience of a drug free life. I believe that suboxone is a great detox tool if used correctly under the care of a physician that is educated not only on the control and distribution of it but educated on addiction and the many faces that it has. Suboxone is just becoming another crutch just like methadone. I have not met anyone who is or was on long term suboxone maintenance that was not still diseased in every other area of there life…I will finish by saying that I also understand that 12 step fellowships are not for everyone and that some have “recovered” through other means but for the addict the only path to recovery in complete abstinence from ALL drugs….our message is hope and the promise is FREEDOM!

My experience of Suboxone maintenance has been similar to yours. I don’t begrudge anyone their path to recovery and if someone says it’s working for them, I accept their work for it and wish them the best. I mostly worry about it becoming standard operating procedure.

Very thoughtful article. I had suboxone for detox (which I crushed and snorted) and I’m glad that instead of a limitless supply I got to attend a long and high quality in-patient program. I read a study that found a positive correlation between the degree of stress an addict was experiencing and the addict’s interest in trying to do something different in their lives i.e. learn about treatment / recovery. Running out of suboxone might be the best thing for some of us.

Most of you people likely have no idea what you are talking about. For one, let this dawn character thinks what she thinks, its her opinion but Who is she? God, no, almighty doctor who knows whats best for every type of addict, no. Ok, here is my point of view, heroin addict-10 years, goes on suboxone, then life is great, tapers and is successfully detoxed. great for him. But DAWN IS SAYING that the next guy, heroin addict 10 years, then suboxone, life great, tapers, not successful, (but dawns view, only short term is right)(which is actually how it still is with most doctors, everyone of them ask patients to come off damn near no matter what after 2-12 months max, which is why most patients will jump from doctor to doctor with no stability all because they want a hard drug free life) lol whoops that was a big parentheses,as i was saying. he was not successful so he relapses, and so dawn is saying screw him. and that pisses me off. I am a person who thinks, ok here are my son’s or daughter’s or whoever’s 2 options. he can be a heroin addict, or he can maintain his addiction through suboxone. hmmmm…”drugs are drugs, screw him!”(most peoples ignorant view) to me its clear, suboxone as a long term treatment is fine with me, if not a godsend.

Ok, but this dawn farm website is promoting that suboxone should only be used for short term. And thats not true, and has actually just been proven in clinical studies that people who stay on it longer have a better chance at remaining abstinent from other drugs. So when I go to google, and type in “suboxone for long term maintenance” and then i click on this dawn farm B.S. of a site thats says
-Over the last several years we’ve watched long-term maintenance become the norm and it has been a growing concern at Dawn Farm, particularly as we’ve had growing numbers of people misusing the drug and others seeking help getting detoxed from buprenorphine.-
It just rubs me the wrong way entirely. Although the reply I just read from you-I guess I’d add that we also want the benefits, limitations and risks accurately communicated to potential clients.-
I do agree completely about that. When a person agrees to go on suboxone, they are not stupid, they know that it is also a mild opiate. And will have to eventually taper and detox from it.

Im sorry I may have been rude, i just read a little more, and there are some good arguments on this website. But most are naive, you expect too much of a weak person who just wants help. I am referring to the amoutn of time people assume addicts should stay on suboxone. And by going against what is considered a miracle drug to some people, you are essentially just trying to make it harder for us to get it. Or limit how we get it, or how long we get it, or why we get it. At the end of the day I see it like this. When a person has extremely high blood pressure and needs his medication, do you think it is right to limit when he can take it? or how long he can take it, “Oh he still has high blood pressure, but this medication is bad for him to, so he shouldn’t take it anymore” then he dies of a heart attack. That is exactly what is happening when doctors fail their suboxone patients by taking them off too early. because then they relapse and die of a heroin overdose. AND THIS IS GOING ON EVERYDAY.

I’m really happy to see light being shed upon the role of Suboxone in recovery. This really hits home for me because I am a former heroin user and alcoholic who is trying to find a way to lead a fufilling life free from drugs. I struggle with chronic and debilitating pain that is a result of my abuse of alcohol. I have a chronically inflamed pancreas which will never heal or repair itself. I have seen pain specialists as well as doctors in addiction medicine in hopes that I could find some kind of alternative treatment (such as a nerve block), but have been told repeatedly that it wouldn’t be an option. These specialists have perscribed me morphine, fentanyl, oxycodone, methadone, and now Suboxone. I have appraised all of my doctors with the severity of my heroin addiction, but this still seems to be the “least worst” scenario for me. The worst part of this is how it has effected my recovery in aa. I started working the steps with a sponsor, but when I finally worked up the nerve to tell him about my condition and its treatment he told me that he could no longer work with me. I suppose I can see my situation from his perspective, but it has led me to seek out other fellowships that I fundamentally can’t agree with because they don’t ascribe to the disease model. I am free from alcohol and have been so for 14 months, but I am very envious of those who are able to go to meetings and be free from all drugs. For me Suboxone may be my last best hope, and I have to believe that there are others in my situation.

I was heavily prescribed opiates for 10 years for chronic back pain. Five months ago I was taking 600 pills a month when I decided to quit. I began a fast taper and hit the wall about half way through. I went to a recovery center for help in quitting and was put on 12 mg of suboxone.
I had no idea at the time what this medication was, only told it would make withdrawals subside. After being sick on it for a week and researching it I forced myself to do a quick taper to 1 mg and then jumped cold turkey. Because of the long half life of suboxone and the way it stacks in your system my detox lasted the better part of a month. It was by far the sickest I have ever been in my 60 years on this earth.
Being a synthetic created in a lab it sticks to the receptors like JB Weld. If you troll the sub forums you will find very, very few people are able to quit suboxone once they have been on maintenance. It is known to be 25-45 more powerful than morphine even though it is a partial agonist. There are charts that show how it stacks because of the long half life and it is freaking scary.
I just thought I would share my experience with suboxone and hope it helps someone else with their decision

I entered recovery in 1980, with gastritis, liver damage and many other medical conditions related to my 14 yrs. of addiction to anything that got me from point a to point b. My story is like so many others. I relished my new found freedom and the joys that my 12 step relationships created and the changes that I labeled spirituality. My wife and I opened an outpatient treatment program in 1986 after having run multiple inpatient programs. I hold a masters in psychology and she is a registerd nurse (also in recovery). Our program grew and, after a very athletic life of football, baseball and horse competitions, I had had times when I was prescribed and took analgaesics like vicodin and codeine. With a heavy dose of fear of these drugs, I never found myself wanting to continue after the initial week or so that they were indicated for my broken bone. However, my football years, as a youth and again an attempt to reclaim those years with thirteen full contact games as a 40 year old, left me with a shoulder that was slowly disintegrating. My physician CAT scanned it and determined that rotator cuffss were torn and a spur had grown that diminished mobility and created pain. Surgery was recommended and obtained in Dec. 2003, with a brief use of pain meds. After stopping all pain meds., one month later, I was on my way to the gym when an elderly man hit my vehicle, spun it around and the result was that all of the repairs to my shoulder were undone. After another cat scan and the choice of surgery or an eight month course of exercise with anaelgesics, I elected for the later. My thinking was that I had never had a problem before and I would keep the dose within the doctor’s orders. All of this was accomplished and I regained full mobility of my shoulder with minimal pain. However, when I tried to come off the hydrocodone, I found that I would slide into a state of anxiety, depression, suicidal thought, insomnia, etc. etc. and that after 45 days, it was getting worse and I had lost 40 lbs. This was 2005 and we had just begun to learn of suboxone. Having worked in a methadone program, early in recovery, I was skeptical. Yet, the two patients that used it reported elimination of all withdrawal and a return to function. with some trepidation and much discussion with my wife, sponsor and other friends in recovery, I started my own medication assisted treatment. I have found that the buprenorphine has fit right in with the aspirin I take for classic migraines and, protonics for acid reflux. All compliment my optimal functionality. I am still full able to experience and express emotions, feel and even deeper connection to my higher power and have absolutely no intention of coming off of the buprenorphine that I take once a day. I am open with my patients and my friends in recovery meetings. I have had second had reports of fellow 12 step members who have criticized my use but none has had the courage to come to me to express their concern for my recovery.
We went through all of this nonsense when anti-depressants were created and I have heard fellows tell others in recovery that if they take their lithium for their bipolar disease, they aren’t really in recovery. It is sad that we do not follow our own organizations teachings to allow an individual to work their own recovery program and leave their healthcare to their physician.
Regarding Dr. Scanlon’s observations regarding an inability to access emotions, I would like to tell him that he is absolutely in error. I, usually, cry daily over something that touches my heart and I watch the patients on buprenorphine in our program, readily access their feelings and have the ability to share them with their peers. Sometimes, I think, we get what we are looking for. Perhaps this is Dr. Scanlon’s experience since, to my knowledge, he has never used buprenorphine. Having used both full agonists and partial agonists (like bup), I can assure you that they are totally and absolutely different in all aspects of physical and psychological effect. I take my suboxone at night when I go to bed and my dose is half what it was when I started.
The old adage “if it ain’t broke, don’t fix it” seems to apply here.
Too many people are dying of opiate addiction and the bias and stigma that surrounds the proper utilization of this medication is unfair to those who will die never knowing that there was hope or stopped because someone they respected told them that they could never achieve recovery without foregoing this option.
I am 63 years old, scuba dive, play tennis, swim, boat and have an active fulfilling life. That is what they promised me in 1980, when I signed up for this recovery thing and, except for the time that I lost before I found this medication, my life has never been better than it is today. To the father of the college son: You have witnessed a miracle, junkies aren’t supposed to be in college, they are supposed to be in caskets. Thank you for supporting your son and may the rest of our field open their eyes and their hearts to see that recovery never follows death.
Rocky Hill MA, NCAC I
I

Dr.Schwartz,
My daugther,29, is herion addict. You wants help, but we as a family can not afford the costs of any help. You mentioned a sponsor, what is this and where do I find out about this help? I have been on the computer many days, looking for help, you either have to have insurance, she has nothing, be on medicad, she can’t get that, where do we go for help? Please help!

Personally I think suboxone is a wonderful and amazing drug, no matter if it used in a short term taper or even in maintenance therapy. Personally I am highly critical of many 12 step ideas. One primary on is the resistance to medication assisted recovery. I’ve seen many examples of peoples revocery and sobriety being called into question because they did so with a medication, or because they currently use a medication. I will say that suboxone saved my life. I went to dawn farm years ago. I was an opiate addict and stayed for approximately 3 months. Afterwards I moved into transitional housing. I personally never agreed with the 12 step treatment model much, even when I was in it. I watched the counselors at dawn farm apply their brand of “tough love treatment” with mixed results at best. They often prided themselves on a pure and rigid AA dogma as a method of attempting to help the patients/residents acheive sobriety.

Many times there it seemed as the goal of the farm and the entire Ann Arbor AA program was to work THE PERFECT AA PROGRAM, instead of finding long term happiness… whether that meant total sobriety, moderation or maintenance therapy. My criticisms of AA and 12 step prgramming are many, but for the purposes of this article I will only address one… medication assisted recovery. I never saw any addiction medicine treatment used at the farm. The treatment for addiction was maintained as a program that was developed in the mid 1930s and remained (proudly and rigidly) unchanged since them, with little to no medical supplementation. Alcoholics did not receive antabuse, campral or naltrexone. I had never once heard of the Sinclair method. Opiate addicts were never talked to about buperenorphine or methadone. =The goal was to “do AA right” instead of providing the best comprehensive therapy to the addicts, with individual plans tapered to each addict to ensure them the highest chances of successful recovery.

Alcoholics anonymous, the 12-steps and the farm did not work for me, I relapsed and returned to a pattern of using as if the thousands of dollars my family had spent on treatment had made no difference. What worked for me was bupe maintenance treatment in association with intensive counseling sessions. I used my time one bupe maintenance to straighten my life out and build a life that I desired to keep and not lose to addiction. Bupe maintenance was a sort of “training wheels” of recovery for me and it worked better than AA ever did. I stayed on it for a year and have since celebrated 3 years of freedom from drug addiction. Suboxone buys time. It allows an addict to live some sort of semblance of a life free of drugs and the freedoms and benefits that come with that.

I was a lucky one however, several of my friends from treatment did not fare so well. I remember a saying alot at the farm… the definition of insanity is doing the same thing over and over and expecting different results. I found this saying extremely ironic considering the practices that were common there. I saw many, many relapses happen. Often times with ther same person 4, 6,6+ times. Each time the poor soul was sent back into the same AA machine. They ended up at detox for a few days and then back to the farm or detox,hoping something would go better this time. It was never that the program might not always work. No, the program was PERFECT, it was a god given cure that ALWAYS worked if a person followed the steps correctly. If someone relapsed the blame was always on them. They hadn’t talked to their sponsor enough, they didn’t read their big book enough, they didn’t go to enough meetings, they didnt do enough service work, they weren’t completely honest…. take your pick. The answer was NEVER “well you know, maybe AA isn’t the right treatment for you, perhaps you should pursue other options. In my 3 years of heavy involvement in the program I never ONCE heard that. Coming off of bupe is a serious decision that a patient needs to make with his doctor. I personally do not really see a problem with someone being on long term bupe maintenance if it allows them a satisfactory quality of life (or A LIFE something those who die of ODs do not have). Some patients remain on SSRIs, blood pressure medications or insulin for the rest of their lives. Why not bupe if the bupe is the reason they HAVE a life at all.

I will not name names, but there are 3 or 4 people who I know from the farm and transitional housing that the program did not work for. After a few relapses they kept being sent in to fight the same fight time and time again, until one relapse they did not come back from. I firmly believe if the farm had been more open to options such as bupe management (or at the very least enforming those in treatments families about it), those people may still be alive today. A certain friend from treatment comes to mind. He passed away last year. He had relapsed I believe twice while living in transitional housing. He did the usual trip to detox for a few days and then back at it. He eventually died of a heroin overdose. We can speculate on these type of things all day, but I firmly believe that bupe maintenance might have saved his life. I saw with my own two eyes that the egos of the AA proponents involved in this young mans treatment were to big to admit that maybe AA didn’t always work. AA and its strict abstinence only model were infallible. This was where I started to become very disenfranchised with the program and even start to actively oppose it. Addiction (specifically opiate addiction) is a very grave matter. It is life or death, and the probability of death with the next relapse is VERY VERY common and real.

To contrast, last month I ran into a friend from treatment. This kid was a “hard case” if there ever was one. He relapsed 4+ times at the farm, spent quite a bit of time in jail. More than once he met up with his heroin dealer at meetings around Ann Arbor while he was in the farms inpatient program. This was perhaps the most hopelessly addicted individual that I have ever seen. I ran into him last month during a social engagement. He has been on bupe maintenance therapy for two years. He is completing a college education and works full time at a very respectable job. Last month he welcomed the birth of a daughter. I firmly believe that his life would not be possible, if it were not for the intervention of bupe.

I could go on and on about this, but I’m at work myself and have things I have to do. In closing I believe bupe is a miracle tool. In combating the deadly affliction of addiction we must do what is possible to give our patients any quality of life possible… ANY life is better than a fatal narcotics overdose. In the life or death battle with addiction there is no room for AAs” abstinence only 100% of the time no matter what” approach. I thank god every day that I saw through that charade and I have a life today that I have the miracle substance of buprenorphine/naloxone to thank!!!

Suboxone is a life saving drug as 8 year heroin addicts my wife and I Let me tell you this. We started out on 8mg suboxone. After the end of the first year 8mg/day each suboxone therapy I had started a business, bought a house and went on a vacation twice. Since then we have been to Hawaii 3 times had a healthy son whos 3 and have been living a great productive tax paying American life yes ALL ON varying doses of SUBOXONE (never over 8mg a day)and a bi monthly psychiatric visit. We are curently on a taper only taking 1mg buprenorphine and .5 naloxone and we will see how this goes personally I do not care either way if we have to stay on or get off we have been taking so little for so long we are addicts yes and will be for the rest of lives yes a fact I damn well know. The only worry I have is that some doctors feel that you should be off the drug over time because of the stigma that should not exist to begin with. I have been to prison and intensive 12 steps/counseling programs 8 hrs a day and my personality never allowed me to take these seriously in most cases sitting around talking about feelings and drug use made me want to use again to be honest. I’ve seen countless people in 12 step programs relapse and spiral downward. Like any addict I have had two or three day relapses most recent a month ago when we had to switch doctors because our doctor told us he will no longer be in the program understanding its a hassel with D.E.A. and such I dont blame him. Look if twelve step programs intensive therapy and all that work for you THIS IS GREAT!!!! DO IT!!! Suboxone worked for us perfectly and part of long term is to get you away from all the people you hung around that are still messing with opiates after 5 yrs on suboxone I can tell you I do not hang out or even see those people any more a lot them are dead or in prison i’ve heard a place I’d be in if not for long term maintanance with suboxone. I tear up “get emotional” watching movies looking at my son sometimes and even tear up hearing others success stories on suboxone as well, feel goosbumps with songs I like I AM ALIVE IN EVERY WAY!!!! and in recovery on suboxone .Please do not knock long term suboxone honestly it’s hard to find negatives of it online this should tell you right there. I cant help but think if the famous dr drew beleived in long term suboxone recovery those opiate addicts that died under his beleifs would still be alive today he has to be rethinking his beleifs at this point and so should everyone else who do not beleive in this therapy it actually works keeps people alive and living productively thats an undeniable fact.

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